Drug prices soar, shortages worsen amid currency crisis

For the Pharmaceutical Society of Nigeria (PSN) and Pharmaceutical Manufacturers Group of the Manufacturers Association of Nigeria (PMG-MAN), a nationwide scarcity of essential medicines, which would result to upsurge in diseases, health complications and deaths is imminent.

The nation was first alerted in February this year, by the two groups, urging the Federal Government to take urgent steps to rectify the situation

They had warned that if the current level of scarcity of foreign exchange (forex) persisted there was going to be threat to drug security in the country.

Most industries in Nigeria still import some active pharmaceutical ingredients like pharmaceutical grain starch, which they need foreign exchange to obtain.

The situation has become so dire, seven months after, because most of the industries have ran out of stock of this basic raw material. The consequence is that they will not be able to manufacture locally any longer, because of absolute drought of raw materials.

Indeed, this will lead to scarcity of essential medicines like painkillers, anti-malarial and antibiotics, and when they are available, it will be at a very high price.

Hospitals will run out of stock, medical treatments will become more unaffordable because the prices of services including drugs have shot up.

The Guardian investigation revealed empty warehouses of many pharmaceutical companies, due to inaccessibility to forex, to directly source finished products, active pharmaceutical ingredients (APIs) and other excipients. It is believed that this will naturally breed out of stock syndrome in the inventory of life saving drugs with obvious consequences in the days and weeks ahead, as most companies will exhaust the leftover stocks from last year.

For instance, the PSN feared that to transact pharmaceutical inclined business at the rate of $1 to N400, will push essential drugs out of the reach of many, thus defeating the goal of the National Drug Policy, which advocates the availability of safe, efficacious and affordable drugs in the health system at all times.

In a communiqué issued at the end of its National Council meeting in Kano and signed by the National President and Secretary, Ahmed I. Yakasai and Gbolagade Iyiola, the PSN said: “Council, after a careful evaluation of the impact of the current paucity of forex in the country, which is gradually grinding operations in drug manufacturing and importation outlets to a halt in the days ahead, appealed to President Muhammadu Buhari, to urgently intervene to prevent an impending national calamity which will lead to morbidity and outright mortality of consumers of health in Nigeria.”

It is also believed that the new policies introduced by the Federal Government, including the National Drug Distribution Guidelines (NDDG) and Common External Tariff (CET) is killing local drug production. It is also feared that the implementation will among other things lead to loss of over 300,000 jobs and dearth of research and development of new products.

The Guardian investigation revealed that the prices of essential medicines in the country have increased by 30 per cent to 42 per cent, depending on the category of drug product. Take for instance, Insulin injection, for the management of diabetes, costs about N1, 200 but will soon go as high as N6, 000. The price of blood transfusion test, a consumable, has shot up from N50 to N170, which is more than 300 per cent increase.

Experts predict that the prices of drugs will soar over 60 per cent of their September 2015 price, by the end of September 2016.

For instance, no pharmaceutical company in Nigeria can function without starch for making tablets but pharmaceutical grain starch is largely imported and the companies are having problems with forex.

Experts fault the Bank of Industry and the Central Bank of Nigeria for not providing pharmaceutical manufacturers with a cash programme, a grant not a loan, to solve the problem of pharmaceutical grain starch. They said Nigeria has several sources of pharmaceutical grain starch; it is just one last step that is needed to convert it to finished product.

However, stakeholders called on the Federal Government to facilitate better access to forex to pharmaceutical companies as a matter of priority, in view of the security dimensions of the out of stock syndrome, which has a propensity to boost the fake drug syndrome, as charlatans will certainly exploit the vacuum created by a lack of basic drugs.

They urged the Federal Ministry of Health (FMoH) to continue to work with pharmaceutical stakeholders who resolved jointly in 2015 to actualize State Drug Distribution Centres (SDDCs), Mega Drug Distribution Centres (MDDCs), Registered Wholesalers and newly introduced Coordinated Wholesale Centres (CWCs), as the main legs of drug wholesaling in Nigeria.

Also, the need to develop a comprehensive and far-reaching medicines’ security policy, which will ensure a robust engagement with medicine security issues has been identified.

There is need for the legislature and other key stakeholders to facilitate enabling environments for maximizing manufacturing capacity for medicines in the country.

The issue was brought to the fore recently at a Forum tagged “Medicines’ security and national self-sufficiency: maximizing medicines’ production capacity in Nigeria.”

Another key issue that had limited local pharmaceutical industries was non-certification by the World Health Organisation (WHO). But today with the help of the National Agency for Food and Drug Administration and Control (NAFDAC) under the leadership of the immediate past Director General, Dr. Paul Orhii, at least five local firms have gained WHO Good Manufacturing Practice (GMP) certification. This achievement has placed Nigeria among the nations of the world whose local drug industries manufacture at the highest international standards.

This step has been identified as a major precursor for the attainment of self –sufficiency, reduction of medical tourism and commencement of substantial exportation of pharmaceutical products to other countries.

It is interesting to know how these pharmaceutical industries steadily hold the forte in contributing towards the nation’s access to safe and high-quality medicines despite the unfavourable local and international environment that had impacted businesses in the industry.

It is believed that ignoring self-sufficiency, as regards medicines would be perilous to the nation, as the issue goes beyond healthcare and even impinges on national security.

Since drugs can be located at the major root of the health and wellbeing of the citizenry, it can also impact on other areas of human performance, just like food, clothing and shelter. This means that it represents an important area of national concern.

Concerns have been raised about Nigeria’s over-dependence on external supply for its drug needs. Government and all key partners have been urged to collaborate to develop a policy milieu that would encourage an increase in the capacity of the local drug manufacturing industries.

The Guardian reliably gathered the country could only achieve drug security when it can produce at least 70 per cent of her drug needs locally. To achieve this, experts advise government to shift emphasis to long-term self-sufficiency of drugs through local production of essential drugs.

Other strategies advocated by several studies included smarter and more purposeful drug procurement processes, which will promote local production of essential drugs. This and other strategies would be underpinned by more comprehensive and robust legislative inputs.

It is believed that there is also need for expeditious harmonization and update of existing drug laws in the country; ensure that the impact of the relevant laws were maximised to facilitate medicines’ self-sufficiency; and ensure effective implementation of policies through proactive oversight functions by the National Assembly.

The Guardian investigation revealed that several laws existed, which could have protected the Nigerian pharmaceutical manufacturing sector, but till now, implementation had been weak. It is believed that the legislature should employ various strategies in ensuring that pharmaceutical manufacturing in Nigeria is protected. This includes, the use of the statutory oversight functions and other enforcement mechanisms that are available to the Nigerian legislature.

To encourage local drug production, experts believe there is need to sanction Ministries Departments and Agencies (MDAs) that discriminate against local manufacturers.

Indeed, providing adequate access to high quality healthcare has always been an intractable challenge in Nigeria since drug therapy forms the majority of healthcare interventions.

There is need to continue the debate on strategies for achieving national self-sufficiency in medicines’ manufacturing.